Virtual Volunteer Application for Groups
First Name
Last Name
Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
Zip Code
Primary Phone Number
Email
Gender
Please select...
Male
Female
Birthday
Emergency Contact Name
Emergency Contact Phone
How did you hear about volunteering?
Please select...
Facebook
Family/Friend
Flyer(s)
Facility employee
TV/Newspaper/Billboard/Ad
Internet
Other
Who did you hear about volunteering from?
Are you part of a group?
Please select...
Yes
No
If yes, which group(s)?
Please select...
Church
Community
Other
School
Group name
Facility you would like to volunteer at
Please select...
Anchor
Bluegrass
Bluffton
Bordeaux
Bowling Green
Bracken County
Bremen
Brookwood
Buckhead
Carrollton
Chapel Hill
Chautauqua
Chesapeake (Bayside)
Chillicothe
Clarksville
Cleveland
Clinton County
College Park
Colonial
Coshocton
Courtyard
Danville
East Louisville
Elizabethton (Pine Ridge)
Elizabethtown
Erin
Fayette County
Fentress
Fort Wayne
Fountain Circle
Gainesville
Galion
Georgetown
Glasgow
Golfcrest
Golfview
Greeneville
Gulfport
Harriman
Harrodsburg
Hart County
Hartford
Heritage Hall
Heritage Park
Hillcrest
Jackson Manor
Jacksonville
Jefferson Manor
Jefferson Place
Kenilworth
Kinston
Lafayette
Lee County
Liberty
Madison (Larkin Springs)
Mallard Bay
Marietta
Mayfair Manor
McCreary County
Memphis
Middleburg
Monroe County
Monteagle
Morgantown
Mountain City
Muncie
Newburgh
Norfolk (Harbour Pointe)
North Florida
North Hardin
Oakview
Orange Park
Ormond
Owensboro (Hermitage)
Palm Beach
Parkwood
Peninsula (Tarpon)
Pickett
Pigeon Forge
Port Charlotte
Portland (Highland)
Prestonsburg
Primacy
Princeton
Putnam County (Cookevlle)
Ridgely
Riverside (Calhoun)
Riverview
Roanoke Rapids
Rockcastle
Rockford
Rockwood
Rogersville
Savannah
South Bend
South Louisville
South Pittsburg
Southern Pines
Spencer County
Spring City
Standing Stone
Sts. Mary & Elizabeth
Summerfield
Summit Manor
Sunrise Manor
Surrey Place
Tanbark
Terre Haute
Tower Road
Trimble (Bedford)
Warren
Washington
Waterford
Westmoreland
Whitesburg
Winter Park
How many are in your group?
Please select...
1-5
6-10
11-20
21-50
>50
Do you have transportation?
Please select...
Yes
No
When can you start?
Virtual Activity interested in - hold the control key down to select multiple items
Please select...
Adopt a grandparent
Be a part of our pen pal program
Design a sign of encouragement and put in home's front yard
Encouragement to Stakeholders
Entertain - Make a movie, sing, play instruments, read stories/scriptures, lead devotionals, magic tricks, demonstrations, etc.
Pray - 24 hour prayer vigil
Send letters/cards/art to bring encouragement to this Signature facility
Support local Signature LTC facility food pantry
Video/Phone visit - by appointment only
Window visits - by appointment only
Window/Sidewalk art - by appointment only
Write devotionals to encourage our staff
Type of Volunteer
Please select...
Indirect
Contact Information